UPI (Provider ID): 6947
Change Report (if Any):

Short Name: NOVA BH-ALLIANC

Long Name 1: NOVA BEHAVIORAL HEALTH
Long Name 2:

Address 1: 1207 WEST STATE STREET SUITE M
Address 2:

City: ALLIANCE
Zip Code: 44601
County: STAR

Contact: CAROL HALES
Title:
Phone: 3308211995
FAX: 3304530007

Vendor: 6708

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012